Hair loss can be treated both medically and surgically. Surgical techniques include Follicular Unit Hair Transplantation (FUT), performed though the microscopic dissection of a donor strip, and Follicular Unit Extraction (FUE), where follicular unit grafts are removed directly from the donor area through tiny round incisions. The latter procedure is now performed robotically (R-FUE).

In hair transplant surgery, hair is harvested from the donor area or “permanent zone,” in the back and sides of the scalp, and then implanted into recipient sites made in the balding areas. Hair follicles from the donor area are genetically resistant to the miniaturizing effects of DHT and maintain this resistance after being transplanted. This is why the cosmetic benefits of a hair transplant are long-term.

The modern hair transplant techniques of Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and Robotic Hair Transplantation (R-FUE, or Robotic FUE) were pioneered by Dr. Bernstein and are now performed by hair transplant surgeons around the world. These procedures, which produce completely natural results, are minimally-invasive and require only local anesthesia. They allow the patient to resume his or her normal activities after a brief recovery period.

Follicular Unit Transplantation (FUT)

In FUT, a strip of hair and skin, called the donor strip, is surgically removed and dissected into naturally occurring follicular units containing from one to four hair follicles. These are implanted in the balding areas where they grow permanent hairs.

FUT generally allows the surgeon to obtain a greater number of follicular units than FUE procedures. It is especially beneficial for patients who wear a longer hair style because the typically fine linear scar that results from the removal of the donor strip can easily be covered and camouflaged with hair. Click here to learn about FUT Hair Transplants.

Introduced in the fall of 2011 by Restoration Robotics, Inc., the ARTAS robot extracts follicular units with accuracy and speed that is impossible with manual FUE instruments. The robot can also utilize its high-tech optical guidance system to create recipient sites according to a plan designed by the surgeon.

Bernstein Medical is one the first hair restoration facilities in the world to use the ARTAS robot and is a beta-test site for improvements to the system. Dr. Bernstein has collaborated with Restoration Robotics to introduce numerous procedural and technological upgrades for the robot. He is a medical adviser to the company. Click here to learn about Robotic Hair Transplants.

Hair Loss Medication

The primary medications used to treat hair loss in men are finasteride and minoxidil. Both drugs act by reversing the miniaturization process (where hair follicles shrink and hairs become progressively finer until they eventually disappear). While the effects are similar, the two medications work by different mechanisms, so the combination of the two will generally give the best results.

Finasteride

Treatment with only finasteride: before (left); after (right)

Treatment with only minoxidil: before (left); after (right)

Treatment with both finasteride and minoxidil: before (left); after (right)

Propecia is the brand name of the oral medication finasteride 1mg. Finasteride also comes in 1mg and 5mg generic tablets.

Finasteride blocks the enzyme 5-alpha reductase Type II from converting testosterone into dihydrotestosterone (DHT), the hormone most responsible for miniaturization, the process that leads to baldness.

As a result of blocking DHT production, finasteride enables follicles to continue to produce healthy, thick terminal hairs. Propecia, introduced in late 1997, continues to be the most effective medication for re-growing hair.

Minoxidil

Rogaine, the brand name of the topical medication minoxidil, counteracts the miniaturizing effects of DHT by lengthening the growth phase of the hair cycle, called anagen. As a result, follicles continue to produce healthy terminal hairs.

Rogaine was introduced as a hair loss treatment in 1982. While it is typically effective in blocking miniaturization in its early stages, it is not as effective as oral finasteride in this regard. Minoxidil is available as a 5% solution, 5% foam, and a 2% formulation (for women). Although the 5% solution is the most effective, it contains propylene glycol which makes it greasy and occasionally irritating to the scalp.

Other Medical Therapies

Low Level Laser Therapy (LLLT)

Low-Level Laser Therapy (LLLT) in hair restoration utilizes cool lasers to stimulate hair growth and reduce hair loss. LLLT is based on the scientific principle of photo-biotherapy which occurs when laser light increases cell metabolism and protein synthesis. Although the exact mechanism by which laser light promotes hair growth is still unknown, it appears to stimulate the follicles on the scalp by increasing energy production and reversing miniaturization.

Recent studies have shown that Low Level Light Laser Therapy (LLT) appears about equal to the benefits of the hair loss medication minoxidil used over the short term. At present, its long-term benefits are less clear.

Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP) is concentrated blood plasma containing approximately five times the number of platelets found in normal circulating blood. In addition, it contains biologic growth factors and other bioactive proteins that aid in wound healing and possibly hair growth. Recently, studies have suggested that PRP may serve as a safe and effective treatment option for common genetic hair loss.

In the medical treatment of male pattern baldness (androgenetic alopecia), PRP can be injected into the balding scalp to potentially stimulate thin (miniaturized) hair to grow into thicker (terminal) hairs. Patients with thinning, but not totally bald, areas would be the best candidates.

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